Do Sleep Centers also serve as DME dealers?

[John Chowder]

Hi all,

newb here who'se just had a titration study. I have a follow up with the sleep doctor in two weeks and am wondering if there's a chance I'll be renting the equipment from the same place that did my study. Or will I simply get a prescription and then call my insurance company for the nearest DME?

I'm just not sure what happens next. Do sleep centers typically sell or rent equipment themselves? Or will they just write the script?

Any info you folks have would be greatly appreciated.

Thanks!

P.S. Merry Christmas!

[49er]

Hi all,

newb here who'se just had a titration study. I have a follow up with the sleep doctor in two weeks and am wondering if there's a chance I'll be renting the equipment from the same place that did my study. Or will I simply get a prescription and then call my insurance company for the nearest DME?

I'm just not sure what happens next. Do sleep centers typically sell or rent equipment themselves? Or will they just write the script?

Any info you folks have would be greatly appreciated.

Thanks!

P.S. Merry Christmas!

Hi John,

Welcome to the forum.

Many sleep centers do but you are under no obligation to buy or rent from them. What I would do is to call your insurance company and get a list of the DMEs near you in your network.

I would then start screening them to see who might be the best candidate. You might want to do a search of the archives on this issue while you wait for members who have more experience than me with DMEs to chime in as to good ways of picking the best candidate.

Best of luck.

49er

[crazyd]

After pressure was determined, the clinic/doc had a list of DME's - categorized by insurance company type and approval, and also they gave me their recommendation of those, but said I could choose my own. The doctor provided that DME a script for the machine, recommending the S9 and I called DME to make sure thats what they would come with to my home to set me up with.

It was run through my insurance for purchase/rent approval before they came to my home for instruction. They spent 40 mins instructing me on use at my home, trying different masks and showing me how to fill humidifier and use settings. It is a purchase/rental agreement with the machine being mine after some time. The DME called me frequently after they set me up at home, to see how I was doing and if I had questions.

[MitzyG]

Hi...I'm new too but I feel so cheated so here's what I would have done, had I figured out what you did BEFORE the agony:

1. Ask for a prescription. That doesn't mean that you HAVE to take it elsewhere, but you CAN. Don't give them money until you get the prescription (a copy of your tests would be good too...I have the first one, need the titration study and I'm sure they're now suspicious and won't give it)
2. DO NOT GIVE THEM THE ENTIRE PAYMENT FOR THE MACHINE! Mine charged me UPFRONT for every future payment before I even saw the machine!
3. If they are doing what mine did...negotiate...tell them you'll pay the first one or two payments but you want to try the machine. Or better...tell them "Dr said that this was a LOANER, so please LOAN me the machine" - after all that's what Dr told me and he owns the place. (they have loaners in the back for free...but they won't tell you that)
4. Don't take the brick...seriously...don't do it. Dr told you you needed auto due to the results of the test...don't leave with a non-auto! If you have to, do what I should have done and googled that cheap crap before leaving, realize it's not the machine Dr prescribed (and he owns the place) and insist on the one that Dr said.
5. If it says "there's a 15% restock fee"...hey, you borrow! Don't buy! These people know you're sleep deprived and will sign anything (they made you that way, waking you up during the test and making you miserable for several days in a row doing this testing).
6. Get an itemized bill. Don't deal with folks who won't!
7. Pre-research the items you're getting to make sure you know what's in the kit because you want to know if they're removing things from the kit then charging you separately for them. Insurance won't care that they're being cheated and CHARGED TWICE for the item that came with the mask/machine.

Frankly, I wish I had just gone elsewhere, this is such a nightmare and while I finally got the machine I wanted, I'm stuck with them for 6 more mos until the insurance is billed for all of the payments. Meanwhile, I want my rebate, I want an accounting of what they charged (on paper, not verbal after they've stuck me with a brick that KEEPS you awake and makes you more sleep deprived than you were in the beginning).

I'm looking for a diff doctor to write a prescription...

[penuel]

John Chowder, you were sent by a physician to the sleep clinic, and an insurer was also involved, right? It could have been your family physician directly or a Sleep Physician. In either case the sleep clinic is obligated to provide the results to the one who ordered it for you. But not to you directly. So you don't have a legal case to obtain it directly from the sleep clinic. Once your physician gets the results then you should be able to receive some kind of a copy. At this point the question of obtaining the appropriate equipment comes into question. You and your physician should decide how to go about it. There are several ways of doing it. Browsing this board you can see the options. By law the physician, the sleep study clinic, and the one who sells the machines, masks, etc., need be separate entities.

[Janknitz]

There's a few realities you MUST understand. Sleep clinics are supposed to be health care providers. While they are profitable, there is an inherent obligation to the patient's best interest. DME's are more like a retail operation. While they have an obligation to the patient, their primary function is to maximize their own profits. So when your health care provider (sleep center) acts as your DME, there is a built-in conflict of interest that works to your disadvantage. Most insurers pay a flat per item fee whether you get the best equipment or the very worst. When your provider profits by outfitting you with the cheapest junk in order to maximize their own profit margin, you LOSE.

In some states, it's illegal for health care providers to do this, for good reason. It may seem like a convenience to you, but it is rarely to your benefit to have your health care provider profit by providing your CPAP equipment.

Please read "What you need to know BEFORE you meet your DME" below in my signature. If you are on Medicare the info is somewhat out of date, but still useful to understand how this all works.

You MUST call your insurer to understand what your own coverage is and how it works. DMEs, even (perhaps especially sleep centers that are also DMEs) are NOT there to make sure you get the best equipment for YOUR needs, they are there to get the best profits for their own needs. If you understand that you have to advocate for yourself among these sharks, you'll be much wiser and be able to recognize when you're about to be taken advantage of.

[John Chowder]

Really good info, thanks everyone!

I did not go through a primary doc this time around, I just searched and found an accredited sleep center near where I live. The first study I had back in 2010 was issued by my then primary doc (I have Aetna PPO now, and no primary doc) and conducted at a non-accredited sleep center. The center seemed fine, they just had to send the results to a doc for interpretation. The results came back with 22.6 AHI so I went back a couple of months later for a titration study. I had an awful night's sleep (2.4 hours of total sleep) and only had time to try one nasal mask (Comfort Gel Blue). I opted for Septoplasty instead.

Three years later, 20 lbs heavier, and I am miserable. Waking up exhausted with headaches, unable to focus, falling asleep in meetings etc. In October a good friend showed me his Swift LT and explained that it can take a bit of time to get used to the mask but if you can do it, it will change your life for the better. I am coming in with a much better attitude this time.

By the way, the 'Success Stories' stickied at the top of this forum is a fantastic idea! I've been pouring over those trying to mentally psyche myself up to my upcoming CPAP life. Much appreciation to you folks who've contributed to that thread. I hope to add my own success story one day.

Anyway, I've contact my insurance company and received a list of the five closest 'in network' DMEs. I have a $250 deductible then they pay 90%, and I'll have to rent the machine for 10 months.

QUESTION: If the Sleep Center offers me a good data capable machine such as the S9 Autoset for a good price, and I buy it from them outright, will my insurance pay for masks down the road even if a claim to buy a machine was never submitted? As long as I have the prescription from the Dr. at the Sleep Center would my insurance honor that? Or would I be better off going through insurance right off the bat?

Also, do you guys have scanned PDFs of your prescription? How does that work with online purchases? Are you able to simply upload your script during the checkout process? I imagine prices here on cpap.com are competitive with DMEs so I imagine that would be a pretty good option.

Thanks for the guidance!

[John Chowder]

Please read "What you need to know BEFORE you meet your DME" below in my signature. If you are on Medicare the info is somewhat out of date, but still useful to understand how this all works.

janknitz, this was incredibly helpful, thank you!

[penuel]

Did Aetna pay for the study? Most likely Aetna follows Medicare requiring a procedure for you to seeing a Doctor if you're doing OK and report after 30 days. How do you know that the one who signed your Rx at the sleep study is a qualified Physician? If you want Aetna to rent you a machine then would they accept this Dr Rx? Usually, if you hold a Physician (and few others who are qualified) Rx then you could buy by providing a copy of it, masks, etc., at Internet sellers for less money.

I myself, was prescribed a plain CPAP. So the DME which I was sent to by the nurse at my Physician office arranged for me a 12 month rental by Medicare of a "Brick" machine. After a month I asked to exchange it and give me a data capable machine. They agreed and gave me an S9 Elite. But still, after listening here to Janknitz and others I wanted an Auto CPAP. But it was too late and b/c it costs more money the DME said no way. So I went back to my Doc and got an Rx for an S9 Autoset. I had to pay from my pockets $850 to the same DME for a new S9 Autoset, flow generator only (b/c it uses the same Dehumidifier that the S9 Elite uses).
After 5 years since I got the S9 Elite, I'll be able to rent a new machine from Medicare. As to CPAP supply I prefer not to bother Medicare for it, and I buy by paying cash from Internet providers.

p.s. check if you could business with this place:

http://www.nationwidemedical.com/

What did you mean by 22.6 API?

[Janknitz]

QUESTION: If the Sleep Center offers me a good data capable machine such as the S9 Autoset for a good price, and I buy it from them outright, will my insurance pay for masks down the road even if a claim to buy a machine was never submitted? As long as I have the prescription from the Dr. at the Sleep Center would my insurance honor that? Or would I be better off going through insurance right off the bat?

Good question to ask your insurance company.

[MitzyG]

Having been through what I've been through, I would say that there is no benefit to you if you buy the machine outright from a DME vs using insurance (unless they're giving you some discount). If you're using a DME, you may be able to borrow for free or for the rental payments. Having used 3 machines, they ARE different! The water tank on the ResMed is so much easier than the other two (it doesn't have a hole on the side where the water comes out and it's easier to fill). The auto is so much better than the cheap brick. The expensive machines are so much quieter than the cheap machine.

If you have some reason you want to buy outright (like avoiding the deductable again...which is getting very close!), you'd want to just do it online where the pricing can be so favorable that non-network benefits could be as good as network benefits. Plus, you are more certain that stuff won't be switched out, you're not getting the machine the previous patient didn't like etc.

3 machines later...I wish I had just gotten a prescription and went with my first thought and avoided the second deductable for next year!!

[neallo]

I will give you an eye popping case. My sleep doctor's office I'd next door to the sleep clinic. When I went in for initial consultation and sleep study was ordered I was directed that when I show up for my sleep study it is next door. After the sleep study and the titration study I goto my sleep doctor and get my prescription and they take it next door for me to get my machine.

The doctor has five or six offices in five Or six cities and next door in each of them is the same sleep clinic co and the dme. I don't know how they are separate institutes.but they are, I guess.